Background After Hirschsprung’s disease (HD) surgery, many children suffer fecal incontinence caused by increased number of high amplitude propagating contractions (HAPCs) propagating through the neorectum to the anal verge. The aim of this study was to determine whether children with HD have more HAPCs than children with colon transections for reasons other than HD. Methods We reviewed 500 colon manometries. Children (7.6±5.1 yrs; 275 male) with functional constipation (n=237; 7.4±5.0yrs; 126 male) and chronic abdominal pain (n=48; 9.8±5.8yrs; 25 male) served as controls compared to subjects with HD (n=56; 6.9±4.1yrs; 44 male) and colon transection for other reasons (n=24; 6.1±5.8yrs; 12 male). We excluded 139 subjects without HAPCs. We documented HAPCs during 1 h fasting and 1 h postprandial. Results are mean ± SD. Results During fasting, HD subjects had more HAPCs (2.2±3.4/h) vs. functional constipation (0.8±2.2/h, p=0.0004) and chronic pain (0.5±1.1/h, p=0.001), but not more than colon transection (1.9±3.2/h, p=1.0). HD showed more postprandial HAPCs (4.0±5.4/h) than functional constipation (1.5±2.5/h, p<0.0001) and chronic pain (0.9±1.6/h, p<0.0001), but not more than colon transection (2.4±3.0/h, p=0.6). There were more HAPCs fasting and post-prandial after colon transection (1.9 ± 3.2/h and 2.4±3.0/h) than functional constipation (0.8±2.2/h, p=0.3 and 1.5±2.5/h, p=1.0) and chronic pain (0.5±1.1/h, p=1.0 and 0.9±1.6, p=1.0). HD subjects were divided by chief complaint: fecal incontinence or constipation. HD subjects with incontinence (n=23) only had more HAPCs fasting (p=0.01) and post-prandial (p=0.01) than HD subjects with constipation (n=28) only. Conclusions Increased HAPCs followed colon transection, regardless of cause. HD subjects with incontinence had more HAPCs than subjects with colon transection for other reasons.

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